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Patients at the Addis Ababa Fistula Hospital in Ethiopia are all treated free of charge, copyright: WHO/P. Virot, Via Wikimedia

“An obstetric fistula,” I said, standing in the pulpit of my 200-year old church, “is a hole between a woman’s vagina and her bowel, or between her vagina and her bladder.”

The congregation’s discomfort was palpable. Later someone told me that they couldn’t believe that I’d had the nerve to say the “v-word” twice! It wasn’t exactly the effect I’d hoped to have, but it wasn’t entirely surprising.

Fistula is a childbirth injury that’s unknown today in the developed West, though before the advent of modern maternity care, it affected women — especially poor women — in America as well as Europe. It was likely the reason, at least in some cases, for a woman being euphemistically spoken or written of as an ‘invalid,’ or as having been ‘invalided’ by the birth of a child. Fistula’s story has always been one of (usually secret) suffering; even the surgery to repair the injury, developed by American gynecologist J. Marion Sims in 1840s Alabama, was performed experimentally upon slaves that Sims purchased for the express purpose of perfecting his technique before turning to white patients.

It’s women of color who still all but exclusively suffer fistula’s life-destroying effects.

Fistula happens when a baby gets stuck while being born, often because a girl is either underage, has a pelvic deformity, or has had her genitals deformed by female genital cutting — and there’s no trained person to help. She’ll labor for days without success. Only after the baby is dead and partially softened does it slip out from the exhausted mother, whose suffering has only begun. Days of pressure from the baby’s head have killed blood vessels in her vaginal tissues, which now decay, leaving a hole — or holes — from which urine and feces leak. She has become incontinent. Her husband divorces her. Her family makes her leave the house because of her stench. She can’t even keep herself clean enough, because the water she walks some distance to collect each day is just enough for basic use. The village children mock her for her stench; her neighbors ignore her.